Is Cognitive Therapy Enduring or are Antidepressant Medications Iatrogenic?

Abstract

Cognitive behavior therapy (CBT) appears to have an enduring effect that reduces risk for subsequent symptom return by half relative to antidepressant medication (ADM) following treatment termination. However, these conclusions are wholly derived from direct comparisons between prior CBT versus prior ADM. Findings from the extended maintenance phase of our most recent trial suggest that CBT provided in combination with ADM does little to prevent subsequent recurrence. These findings raise the concern that adding ADM may interfere with the enduring effects of CBT as they do in panic. Moreover, depression appears to have “coarsened” over recent decades and there are concerns that ADM may suppress symptoms at the expense of prolonging the underlying episode. ADMs are known to work by perturbing the complex homeostatic regulatory systems that underlie affective response and differences in that perturbation are associated with risk for relapse following medication discontinuation. It remains unclear whether CBT truly has an enduring effect or ADMs an iatrogenic effect that that interferes with CBT’s enduring effect or (worse) prolongs the length of the underlying episode. Studies are described that could resolve this issue and their implications.